How to write an Advanced Health Assessment paper from Acquifer  case studies

How to write an Advanced Health Assessment paper from Acquifer  case studies

Domain: History: 1a) Identify two (2) additional questions that were not asked in the case study and should have been?

The first question that was not asked concerns the patient’s weight management. “How often do you exercise?”

The second question that was not asked involves aggravating and relieving factors. “Are there any activities that worsen or relieve your symptoms?”

1b) Explain your rationale for asking these two additional questions.

It is important to understand the patient’s weight management program because overweight and obesity are associated with asthma (McCracken et al., 2017). Additionally, understanding if the patient does exercise can help to detect whether it is one of the aggravating or relieving factors to his symptoms. Asking about the relieving and aggravating factors can help the provider to rule out other conditions. For example, worsening symptoms at night or during cold conditions can indicate conditions like asthma.

1c) Describe what the two (2) additional questions might reveal about

the patient’s health.

Asking these questions will help reveal the current health status of the patient and aid in formulating a diagnosis. Weight management is an important factor for patients with respiratory conditions like pneumonia, asthma, and COPD (Gans & Gavrilova, 2020). The questions will also reveal what diagnostic tests might be required during planning for treatment and follow-up.

 

 Domain: Physical exam

2a) Explain the reason the provider examined each system.

Physical examination and review of systems are integral parts of an evidence-based nursing assessment. Examining all the body systems is important to detect the root cause of the problem that might otherwise go unnoticed. It was important for the provider to review different systems for identification of underlying causes and to guide focused examination on key body systems. Examination of the systems later helped in guiding the objective portion of the health assessment.

2b) Describe how the exam findings would be abnormal based on the information in this case. If it is a wellness visit, based on the patient\’s age, describe what exam findings could be abnormal.

Abnormal findings, in this case, include coughing several times a week at night. On examination, there is swelling of the inferior turbinates of the nose. Pallor of the nasal mucosa with some clear drainage is found. Examination of the chest reveals mild scattered wheezes. Other findings are normal.

2c) Describe the normal findings for each system.

The first part of the examination reveals normal vital signs; Temperature is 36.8 C (98.2 F), Pulse is 80 beats/minute, Respiratory rate is 16 breaths/minute, Oxygen saturation is 97% in room air, and Blood pressure is 118/68 mm/Hg. The eyes are clear with no discharge with an examination of the ears revealing normal tympanic membranes. There is no frontal or maxillary sinus tenderness, no signs of postnasal discharge in the throat, and the carotid pulse, thyroid, and lymph nodes are normal on examination of the neck. Examination of the chest reveals normal symmetrical expansion and recoil with all areas resonant to percussion. The S1 and S2 heart sounds are heard with no murmurs. Examination of the skin reveals no areas of eczema or lesions and the extremities have no cyanosis or edema. Mental health status examination reveals orientation to time, place, and situation with proper display of appropriate affect.

2d) Identify the various diagnostic instruments you would need to use to examine this patient.

Examination of the patient will require instruments like a blood pressure machine, stethoscope, otoscope, ophthalmoscope, penlight, thermometer, and tongue depressor.

DOMAIN: ASSESSMENT (Medical Diagnosis)

Discuss the pathophysiology of the:

3a) Diagnosis and,

Based on the symptoms, asthma is the most likely diagnosis for the patient. Asthma is a common chronic condition of the airways that manifests with recurring symptoms of airflow obstruction, bronchial hyperresponsiveness, and inflammation (Gans & Gavrilova, 2020). The dominant physiological event leading to clinical symptoms is airway narrowing that interferes with airflow. During bronchoconstriction, there is an interaction of various inflammatory cells including mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells that are activated due to allergy or presence of irritants (Gans & Gavrilova, 2020). As the inflammation becomes more persistent, edema and mucus hypersecretion is observed as well as structural changes like hypertrophy of airway smooth muscles. These changes further cause airway hyperresponsiveness that results in a more worsening disease. Lastly, airway remodeling that involves an attempt to rectify the structural changes occurs which further causes more damage that may be irreversible (Gans & Gavrilova, 2020). Consequently, the patient becomes less responsive to therapy.

3b) Each Differential Diagnosis

The first differential diagnosis based on the patient’s symptoms is chronic obstructive pulmonary disease (COPD). COPD is a condition that affects the lungs is characterized by persistent respiratory symptoms and airway limitation (Gundry, 2020). The condition results from a combination of processes that cause peripheral airway inflammation. Airflow becomes limited due to inflammation and eventually, the alveoli and terminal bronchioles supplying the lungs become destroyed. The result is a severe obstruction of airflow, increased inflammation, and fibrosis due to the presence of exudates (Gundry, 2020). Blockage of airflow causes trapping of air resulting in a reduced inspiratory capacity that manifests with breathlessness on exertion and inability to breath well during exercise.

The other differential for the patient is nonasthmatic eosinophilic bronchitis that is a common cause of chronic cough. During the build-up of the disease, superficial airways become inflamed due to mast cell activation (Yıldız & Dülger, 2018). Other key players include histamine and prostaglandins that cause inflammation. The inflammation is mostly caused by increased cough reflex but the absence of airway hyperresponsiveness differentiates it from asthma.

Domain: Laboratory & diagnostic tests

4a) What labs should be ordered in the case?

The patient does not present with signs of infection that might require laboratory investigations at this time. However, a complete blood count and blood and sputum eosinophils test can be done.

 

4b) Discuss what lab results would be abnormal.

Elevated white blood cells are likely to be observed in a patient with inflammation. Blood eosinophilia greater than 4% will be abnormal (Gans & Gavrilova, 2020). These results will be consistent with a diagnosis of asthma.

4c) Discuss what the abnormal lab values indicate.

An increased white blood cell count will indicate the presence of an infection. Further tests may be required to determine the actual cause of the disease. Blood eosinophilia greater than 4% will indicate the presence of chronic diseases like asthma or bronchitis.

4d) Discuss what diagnostic procedures you might want to order based on the medical diagnosis.

The first test that I will consider is spirometry to measure lung function. Measures including FVC, FEV1, and FEV1/FVC ratio are used to determine the presence of airway obstruction (McCracken et al., 2017). The second test I will order is peak expiratory flow to measure airway resistance. Variability throughout the day measures can easily indicate if the patient is asthmatic. Lastly, conclusive results if the FEV1 is below 0.7 can be obtained using inhaled mannitol or methacholine challenge test.

 

 

References

Gans, M. D., & Gavrilova, T. (2020). Understanding the immunology of asthma: Pathophysiology, biomarkers, and treatments for asthma endotypes. Paediatric Respiratory Reviews, 36, 118–127. https://doi.org/10.1016/j.prrv.2019.08.002

Gundry, S. (2019). COPD 1: Pathophysiology, diagnosis and prognosis. Nursing Times, 116(4)27-30. https://www.nursingtimes.net/clinical-archive/respiratory-clinical-archive/copd-1-pathophysiology-diagnosis-and-prognosis-23-03-2020/

McCracken, J. L., Veeranki, S. P., Ameredes, B. T., & Calhoun, W. J. (2017). Diagnosis and management of asthma in adults: A review. JAMA, 318(3), 279–290. https://doi.org/10.1001/jama.2017.8372

Yıldız, T., & Dülger, S. (2018). Non-astmatic eosinophilic bronchitis. Turkish Thoracic Journal, 19(1), 41–45. https://doi.org/10.5152/TurkThoracJ.2017.17017

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